Provider Demographics
NPI:1740387547
Name:KHAN, KHADIJA T (MD)
Entity Type:Individual
Prefix:
First Name:KHADIJA
Middle Name:T
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5970
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5312
Mailing Address - Country:US
Mailing Address - Phone:630-424-9204
Mailing Address - Fax:630-424-4783
Practice Address - Street 1:2803 BUTTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1165
Practice Address - Country:US
Practice Address - Phone:630-424-9204
Practice Address - Fax:630-424-4783
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360889832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2227259OtherBCBS PROVIDER NUMBER